WentWest is focused on reforming the mental health system through its role as the Western Sydney Primary Health Network. It aims to [1] commission new services to address gaps, [2] meaningfully engage consumers in decision making, and [3] better integrate mental health services with primary care. This will help shift the focus from crisis services to prevention and coordinated care across the continuum.

1. 1
PHN role in Mental Health
Reform
Adj. A/Prof Walter Kmet
CEO WentWest, WSPHN
Implementing Mental Health
Reform
1 June 2016

2. 2
PHN role in mental health
reform
1. Context of our work
2. Commissioning
3. Consumer engagement
4. Integration

3. 3

4. 4
Key system wide problems*
More efficient and sustainable approaches are needed to
improve the system for individuals, across the life course and
across illness severity, and to improve targeting of efforts.
• Fragmentation, inefficiency, duplication and
a lack of planning and coordination at a local level
• Service delivery based on the needs of providers,
rather than on consumer choice
• Waiting too late to intervene to offer services for people
with mental illness, with an imbalanced focus on acute,
crisis and disability services rather than prevention
and early intervention
• A ‘one size fits all’ approach to service delivery that does
not optimally match or meet individual needs
• Underutilisation of innovative approaches to use workforce
and technology
Government Response to Mental Health Review 2015

5. 5
Identifying opportunities for
health system improvement
Western
Sydney PHN –
Health system
Improvement
opportunities
Whole-of-system (Macro level):
Enhanced structural integration
across the various health services
serving the population of western
Sydney and covering both private
and public health sectors.
Care/population groups (Meso level):
Enhanced service integration for
targeted health initiatives including
local and national priority focus areas
and/or sub-populations that have
been identified as a result of PHN
population needs analyses.
Patient-centric integrated and
coordinated care (Micro level):
Improved delivery of patient-centric
health services to individuals and
their carers through a coordinated
set of care interventions that ensure
the right care is provided in the right
place at the right time.
Advocac
y
Commissionin
g
Integration
Western Sydney
PHN – Health
system
Improvement
opportunities

6. 6
WSPHN:
Domains of
investment
for a new
model of
mental
health in
primary and
community
care

7. 7
PHN mental health priority
areas
1. Aboriginal and Torres Straits Islander People
2. Low intensity services
3. Psychological Services to hard to reach groups
4. Children and Youth
5. Severe Mental illness and care packages in
Primary Care
6. Suicide Prevention
7. Regional Plan
8. Stepped care

8. 8
Strengthening mental health across
continuum of care
Stepped Care

9. 9
• undertake comprehensive regional mental
health planning and identify primary mental
health care service gaps within a stepped
care approach
• develop approaches to new service areas to
broaden the service mix, such as low
intensity services and, and services for young
people with severe mental illness
• promote a stepped care approach and better
target appropriate referral to mental health
and related services
• develop linkages with and between relevant
services and supports
• establish mental health specific clinical
governance arrangements
In 16-17 PHNs will be expected
to:

10. 10
Longer term PHNs will be
expected to:
• implement the core elements of a stepped
care approach
• plan, develop, target and/or commission
services to achieve an appropriate service
mix
• address the six priorities identified for the
flexible funding pool within a stepped care
approach
• ensure most efficient use of resources
develop and implement efficient and timely
service pathways
• actively promote use of the digital mental
health gateway as a core element of a
stepped care approach

11. 11
Shifting focus & investment

12. 12
PHN role in mental health
reform
1. Context of our work
2. Commissioning
3. Consumer engagement
4. Integration

13. 13
Commissioning is
“a strategic
process of working
with the market to
co-design, co-
deliver and
actively manage
services to most
effectively and
efficiently meet
the needs and
improve outcomes
of a defined
population within
resources
available”

14. 14
1. Understand the needs of the community by analysing data,
engaging and consulting with consumers, clinicians, carers and
providers, peak bodies, community organisations and funders.
2. Engage with potential service providers well in advance of
commissioning new services.
3. Putting outcomes for users at the heart of the strategic
planning process.
4. Adopt a whole of system approach to meeting health needs
and delivering improved health outcomes.
5. Understand the fullest practical range of providers including
the contribution they could make to delivering outcomes and
addressing market failure and gaps, and encourage diversity
in the market.
6. Co-design solutions; engage with stakeholders, including
consumer representatives, peak bodies, community
organisations, potential providers and other funders, to
develop evidence-based and outcome-focused solutions.
PHN Commissioning
Principles

15. 15
7. Consider investing in the capacity of providers and
consumers, particularly in relation to hard-to-reach
groups.
8. Ensure procurement and contracting processes are
transparent and fair, facilitating the involvement of the
broadest range of suppliers, including alternative
arrangements such as consortia building where
appropriate.
9. Manage through relationships; work in partnership,
building connections at multiple levels of partner
organisations and facilitate links between stakeholders.
10. Develop environments high in trust through collaborative
governance, shared decision-making and collective
performance management.
11. Ensure efficiency, value for money, and service
enhancement.
12. Monitor and evaluate through regular performance
PHN Commissioning
Principles

16. 16
Underpinning need for effective
collaborations and partnerships

17. 17

18. 18
Our role beyond “health”
Impact on the health system is largely a function of the
environment people live in
health environment

19. 19
Critical success factors –
some thoughts
• Shared vision and principles of operation
• Building on existing relationships, some
formal
• Leadership and investment in developing
change
• Providing consumers with great transparency
about their options and progress in dealing
with health issues
• Defining where existing silos/organisations
and “pitch in” and add value roles and
responsibilities
• Allocating resources including systems and
money

20. 20
PHN role in mental health
reform
1. Context of our work
2. Commissioning
3. Consumer engagement
4. Integration

21. 21
What We Know
Just one third of people experiencing mental
health distress (illness) had received
services for their mental health problems.
Two thirds of the people with a mental
health problem did not seek help, with over
90% reported that they did not need
services.
National Survey of Mental Health & Wellbeing

22. 22
75%
22%
3%
One disorder
Two disorders
Three disorders
Mental Health Comorbidity
National Survey of Mental Health & Wellbeing

23. 23
People Diagnosed with
a Mental Illness
Die 10 – 32 Years younger than average
(exc Suicide)
70% Unemployed (more than an other
disability)
17% contact with friends or family 4 – 8
times per year
20% of people referred to MH Services are
identified as having significant problems
with their living conditions
3X more likely to be in debt that other
people
More likely to be divorced and many neverNational Report Care MHC 2012

24. 24
Cultural Diversity
For recent arrivals from Somalia, Sri Lanka
and Myanmar it is unlikely that relevant
cultural issues will be understood and
incorporated in to the treatment program.
Many Communities particularly, Asian
Communities, access public mental health
service at less that half the rate of the
general population.
MHIMA 2013

25. 25
There are gaps – a “missing
middle”
• Lack of high intensity day care
- Deskilling of the day care staff – shift to NGOs
• Lack of residential care (24 hours non medical
support)
• Lack of community intensive residential care (24
hours medical support provided outside the hospital)
• Lack of comprehensive information in the non-health
sector
- Housing: not able to know how many properties
for people with MH problems
- Problem for indicator-based planning
• A reactive system, rather than proactive long term
planning (based on short term care programs).
• High availability of services aimed at careWestern Sydney Mental Health Atlas 2015

26. 26
Consumer & Community
Engagement Model

27. 27
Consumers being involved at all levels
• Investment of better literacy, support and
transparency of information
• Governance, planning and design of
service provision
• Evaluation of services
• Opportunities for peer engagement
“Nothing about us
without us”
Consumer centred co-
design

28. 28
PHN role in mental health
reform
1. Context of our work
2. Commissioning
3. Consumer engagement
4. Integration

29. 29

30. 30
A vision for our health system
Care, which imposes the patient’s
perspective as the organising principle
of service delivery and makes
redundant old supply-driven models of
care provision. Integrated care
enables health and social care
provision that is flexible, personalised,
and seamless.
(Lloyd & Wait 2005)The structure of service delivery should be a function what
we need now not the default of what has always been there

31. 31
Defining an outcome from
integration
At its heart , it can be defined
as an approach that seeks to
improve the quality of care
for individual patients, service
users and carers by ensuring
that services are well co-
ordinated around their needs
(Kings Fund 2012)“Improving the patient journey through developing
integrated and coordinated services”

32. 32
Strengthening building
blocks of an integrated care
system
Support with Enablers
Payment Governance Information Leadership Support
“Quadruple Aim”
Organise Delivery
Protocols
Care
plans
Performance
review
Care
coordination
and delivery
Understand Needs
Low risk
Moderate
risk
High risk
Very low
risk
Very high
risk

33. 33
The Quadruple Aim of
Effective Care

34. 34
Rethinking Primary Care
Source: UCSF Center for Excellence in Primary Care. http://www.ucsf.edu/news/2014/08/116856/team-based-approach-primary-c

35. 35
GP Survey - WSPHN

36. 36
A shared care plan is a structured,
comprehensive plan developed
jointly by the patient and their
family/carer and health
professional(s). It may include a
summary of personal health
information, a person’s health
goals, and the treatment and follow
up care they receive.
National Health IT Board NZ

37. 37
Integration of mental
health & primary care
• Taking in account the local context
• Engaging in formal/informal partnerships
• Articulating governance/identifying
leadership
• Reforming the way we pay
• Establishing (common) infrastructure
• Accounting for organisational culture
• Encouraging respectful communication
• Providing inter-professional education
• Reducing stigmatisation & discrimination
• Collecting data/information to assess
PCHRIS 2015

38. 38
How do we integrate care?
Connecting/coordinatin
g
AND
Changing/transforming

39. 39
Thank you
@WKmet

40. 40
As the Western Sydney Primary Health Network,
WentWest is focused on addressing both regional
and national health challenges. Together with
health professionals, partners from both the
health and hospital sector, consumers and the
broader community, WentWest seeks to identify
gaps and commission solutions for better health
outcomes.